The waiting game
WAIT TIMES ARE ON THE RISE IN B.C.
Earlier this month, one of Dr. Brian Day’s patients, a 38-year-old mother of two young kids and an elementary-school teacher, walked into his office on crutches. She had been injured at work while demonstrating a sports drill and needed knee surgery. She had her operation the next day.
As a workers’ compensation claimant who had become hurt on the job, the woman went straight to the front of the line. As the medical director of the privately run Cambie Surgery Centre, Day says that, through the public system, the surgery would have involved the patient waiting six months to see a surgeon, then another six to 12 for the procedure.
“That’s the difference,” Day says. “It’s ludicrous. If you keep people off work for a long time, they get worse while they’re waiting.”
The latest data shows not only that lengthy wait times are a reality for Canadians, but also that, in many parts of the country, including British Columbia, the waits are getting worse.
According to the 2016 annual waiting list survey from the Fraser Institute think-tank, the total waiting time between referral from a general practitioner and the delivery of medically necessary elective treatment by a specialist in Canada rose to 20 weeks last year, up from 18.3 weeks in 2015. The survey had a response rate of 21 per cent.
The report breaks down wait times into two consecutive segments: first, from referral by a general practitioner to consultation with a specialist; and secondly, from consultation with a specialist to the point at which the patient receives treatment.
In the first segment, to see a specialist, wait times rose to 9.4 weeks in 2016 from 8.5 weeks in 2015. This duration is 155 per cent longer than it was in 1993, at 3.7 weeks.
The time it took between seeing a specialist and having treatment, meanwhile, climbed to 10.6 weeks in 2016 from 9.8 weeks from the year before — representing a wait that’s 88 per cent longer than in 1993, when it was 5.6 weeks — and more than three weeks longer than what physicians consider to be clinically reasonable.
Among various specialties, the shortest total wait times exist for medical oncology (3.7 weeks), while patients wait longest between a referral by a GP and neurosurgery (46.9 weeks) and orthopaedic surgery (38 weeks).
Since 2015, wait times to see a specialist has decreased in three provinces and stayed the same in one, but gone up in B.C., among other places. Waiting times from specialist consultation to treatment showed the same pattern: down in three provinces, the same in one, and up in B.C. and other areas.
In fact, B.C. had some of the longest specialist-to-treatment waits in the country, at 14.5 weeks, compared to 7.9 in Saskatchewan.
According to the Fraser Institute, research shows that wait times can have serious consequences, such as increased pain, suffering and mental anguish, as well as poorer medical outcomes. In many cases, patients may also have to forgo their wages while they wait for treatment.
Day is a leading a challenge in a constitutional case in B.C. Supreme Court, arguing that provincial laws prohibiting doctors from charging patients for expedited medically necessary treatment and services in private clinics — thereby enabling people to bypass long waits for many non-emergency procedures in the public health-care system — violate people’s constitutional rights. (The case is currently on hold while plaintiffs raise money for legal fees.)
Making matters more complicated, Day says, is that people from other provinces are legally allowed to use private insurance and skip the public queue for procedures here. And those who’ve been waiting long periods may be able to have their publicly funded surgery done in a private centre if health authorities have outsourcing contracts in place.
“So we have a situation in which people from outside the province have rights under the law that are denied to you,” Day says. “If public hospitals or authorities decide the waits are bad, the government can contact a private clinic to get you treated more quickly. The government is saying ‘we can decide that you are in a situation where we need to expedite your treatment,’ but you as an individual don’t have that same authority.”
Government data show that about 85,000 British Columbians are currently waiting for surgery, a figure Day says is in fact much higher. Cambie Surgery Centre also offers colonoscopies to people willing and able to pay to have the test done within weeks rather months via the public system. One of the plaintiffs in the court case, he says, is a patient who was on a wait list for a colonoscopy and opted for a faster, private test, only to learn she had cancer. “This is a patient whose life was saved,” Day suggests.
Those who oppose Day’s view say that allowing people to pay for private services will result in a twotiered system, one for the rich and one for the poor in which those with money will have more privileges and access to better care. A U.S.-style approach, opponents say, drains resources from the public system and will ultimately destroy Canadian Medicare.
Operators of other private clinics say that while they can’t address wait times, they can help save people time.
Copeman Healthcare Centre is a primary-care centre that operates with an interdisciplinary team that includes dietitians, physiotherapists, psychologists and others. Because it doesn’t have surgeons on staff, it can’t address wait times for operations.
It does, however, have on-site diagnostic and lab services, meaning patients don’t need to take a requisition slip to a facility elsewhere, thereby avoiding the waits that typically accompany blood work or other tests.
“The No. 1 commodity that our clients do not have, and that I would argue almost nobody has, is extra time,” says Les Jickling, senior director of marketing and communications. “Everyone is strapped for time. With everything we do here, we try to save people time.”
Appointments last up to 30 minutes, so people don’t need to make multiple bookings to discuss more than one health concern.
The clinic has a metric to measure whether appointments are running on time. Jickling says that in 95 per cent of cases, people are seen within 10 minutes of their scheduled time.
“That’s very different from the norm where you would wait an hour for a seven- to 15-minute appointment,” Jickling says.